The pericardial space provides an advantageous approach for many medical procedures. For some procedures, an epicardial approach to the heart may provide more direct access with fewer risks, such as the risk of clotting or other embolic events (e.g., release of device debris, air, and the like), e.g., as compared to endovascular approaches. Recently, there has been a large increase in the number of therapies designed to access and treat the heart via an epicardial approach—both via a subxyphoid access as well as surgical access. Many of these treatments require careful positioning, e.g., to target specific areas as well as to avoid other specific areas. These areas can include atrial appendages, coronary arteries, coronary veins, fat pads, separate/individual chambers of the heart and/or walls thereof, and the like. These anatomies are difficult to visualize in general using standard imaging modalities, such as fluoroscopy or ultrasound, where resolution is poor and/or the ability to deliver and contain contrast is difficult, which may present a real and significant challenge to the development of truly therapeutic devices and procedures.
Likewise, fluid management in the pericardial space is critical to the overall success and safety of the procedure. Excess fluid in the pericardial space may compress the heart and reduce cardiac output. In the extreme, this may lead to cardiac tamponade. Furthermore, introduced fluid that is electrically insulating, e.g. air, can increase defibrillation thresholds, which can be dangerous in the event the patient develops a shockable arrhythmia during the procedure and requires cardioversion.
Therefore, apparatus and methods that facilitate medical procedures via epicardial approach would be useful.